Objective To estimate the efficacy and safety of percutaneous coronary intervention (PCI) on the very old patients with acute myocardial infarction (AMI). Methods A retrospective analysis was carried out on 78 very old patients (≥80 years old) with AMI in our hospital in recent 5 years. Of them, 40 patients underwent PCI therapy and 38 patients received conservative drug treatment. The general clinical data, and clinical therapy efficacy during hospitalization and in 6 months of follow-up were collected and analyzed in 2 groups. Results Compared with the conservative drug treatment group, the relief rate of myocardial infarction symptoms was significantly increased (52.63% vs 75.00%, P＜0.05) and the incidence of heart failure during hospitalization was significantly decreased (39.47% vs 15.00%, P＜0.05) in PCI group. Moreover, the incidence of recurrence angina (42.86% vs 18.42%) and myocardial infarction (22.86% vs 5.26%) in 6 months after discharge were significantly decreased (P＜0.05), and cardiovascular events and sudden death were also reduced in PCI group compared with conservative drug treatment group (25.71% vs 10.52%, P＝0.09). Conclusion PCI therapy greatly improves the clinical symptoms and prognosis, and the quality of life in the very old patients with AMI. Therefore, PCI is a safe and effective treatment for the very old patients with AMI.